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目的 探讨急性心肌梗死(AMI)早期心电图(ECG)ST在不同导联的改变对梗死部位相关动脉(IRA)的诊断价值。方法将21例AMI的早期ECG与冠状动脉造影结果进行对比分析。结果 ①胸前导联ST段抬高是左前降支(LAD)梗死最常见的表现。ST_(aVL)和/或V(1～4)抬高诊断的敏感性均为83％,特异性分别为100％、93％,阳性预测值分别为100％、83％。②ST_(Ⅱ/Ⅲ)>1,ST_1等电线+V_(1～2)压低以及STα_(5-8)抬高对预测单支LCA具有较高价值。敏感性均为100％,特异性分别为100％、100％、82％,阳性预测值分别为100％、100％、67％。③ST_(Ⅲ/Ⅱ)>1对RCA诊断敏感性100％、特异性83％、阳性预测值90％。ST_(Ⅱ、Ⅲ、aVF)抬高+V(4～6)压低提示有多支血管病变,特别是有LCA,敏感性为60％,特异性,阳性预测值均为100％。
Objective To investigate the diagnostic value of different lead changes on the infarct-related artery (IRA) in the early stage of acute myocardial infarction (AMI). Methods 21 cases of AMI early ECG and coronary angiography results were compared. Results ① ST-segment elevation of the lead in the chest was the most common manifestation of infarction in LAD. The sensitivities of ST_ (aVL) and / or V (1 ~ 4) elevation diagnosis were 83%, 100% and 93% respectively, and the positive predictive values were 100% and 83% respectively. (2) ST_ (Ⅱ / Ⅲ)> 1, ST_1 et al. V_ (1 ~ 2) depression and STα_ (5-8) elevation have higher value for predicting single branch LCA. Sensitivity were 100%, specificity were 100%, 100%, 82%, positive predictive value were 100%, 100%, 67%. ③ST_ (Ⅲ / Ⅱ)> 1 was 100% sensitive, 83% specific and 90% positive for RCA. ST_ (Ⅱ, Ⅲ, aVF) elevation + V (4 ~ 6) depression prompted multivessel disease, especially with LCA, the sensitivity was 60%, specificity, the positive predictive value was 100%.